Switch On Your HIV Smarts.

Promiscuous Gay Nerd: Wishing and Hoping and Praying—How Not to Prevent HIV

I’d be lying if I said I didn’t feel just a twinge of disappointment when my trick-du-jour, Jason, reached over to the nightstand to fetch a condom. But while it wasn’t exactly the entrée I would have ordered, I didn’t argue—I wanted him to feel comfortable and to do what he needed to do.

Unbeknownst to Jason, I was in the middle of a personal experiment. For most of my adult life, I had striven to use condoms as often as possible but, like many gay men, that ambition often gave way to desire. I started taking PrEP last year precisely for that reason: I was hardly ever using condoms and I recognized that I was a prime candidate for HIV infection. I knew that taking PrEP once a day could almost entirely eliminate my risk of testing positive. I felt emboldened by the newfound safety of condomless sex to be more explicit about my preference for it. Why beat around the bush? Why not ask for what you want?

I quickly realized that talking about condomless sex is like breaking the first rule of Fight Club. Time after time, I would hook up with guys who said they were looking for sex with condoms and time and time again they’d fuck me raw. But naming that desire and being open about it was a serious deal breaker for many guys. It marked me as a dangerous bad boy.

Although I felt conflicted about playing such a trite and ridiculous game, I realized that if I wanted to get laid I’d have to play along. Thus, fast-forward a couple weeks, and there I am, face-to-face with Jason in bed. After fucking around with the condom for a while, he collapsed and begged for a break. He took the condom off and we lay next to each other, idly touching each other and making small talk, eventually becoming more and more entangled in each other’s arms. And then he was on top of me, his big green eyes locked on mine. He reached down and pushed back inside of me, no condom and no question. It felt…exhilarating. Intimate. Sexy.

As I sat gossiping about my romp with Jason the next day over pancakes and mimosas with a friend, I wondered out loud why he even bothered with the condom in the first place. “What a dog and pony show!” My friend sat across from me, staring quizzically into his plate of syrupy pancakes. “Weird. It’s like he was trying to show you that he’s a good boy.”

Reflecting on the experience, I realized that it wasn’t the first time this has happened. A few years back, I had a fuck buddy (also named Jake) who would always fuck me first with a condom and second without. With few exceptions, every time we’d bone he’d use a condom the first round and go bare the second. At the time, I found the whole bit a bit odd—and of course crazy erotic, if a bit silly.

Recent experiences cruising for sex online suggest that these experiences may not be entirely isolated. Over the past year, I’ve noticed that some guys are moving away from looking for “safe sex” and are instead looking for “safe guys.” This probably seems like an innocuous difference to some readers, but semantics matter. Let’s think about what they’re saying: They’re not saying they want to have safe sex, per se, but rather they’re looking to have sex with guys that are “safe.” In other words, safe isn’t a description of a behavior but rather a description of a kind of person. A good person. A normal person.

Thinking about this from a sociological perspective, this isn’t altogether surprising. Guys have for many years now described themselves as “barebackers,” and/or used more veiled terms such as “uninhibited.” These guys were staking out territory against the norm. If enough guys are out there calling themselves barebackers, eventually people who don’t identify as such are going to wonder what to call themselves. In a world where you have to contend with a growing number of self-identified barebackers, it makes sense that some guys feel the need to identify themselves as “normal”—whatever that may mean.

It may well be that we’re smack dab in the middle of a moment when “safer sex” is playing catch-up to the barebackers. If this is indeed what’s happening, it’s bound to have some pretty dire consequences for HIV, gay men’s health, and sexuality more generally. Let me suggest a few reasons we should be concerned.

First, at the most general level, it’s just another way to divide the community between those who are “normal” and those who are “deviants.” We’ve already found a million ways to do this—from the barrage of “no fats, femmes, or Asians” profiles to the chasm that largely keeps neg and poz guys apart. Gay men can already barely stand to be in the same room with each other; the magical categories of “safe” and “clean” will only serve to drive us further apart. It might be one thing if it actually was a useful way to prevent HIV, but as I’ll say more about in a minute, it’s just a kind of stigma that does more to fuel new infections rather than quell them.

Second, and perhaps more importantly, it’s a new example of an age-old problem in the world of HIV that some would cheekily call “magical thinking.” It relies on a wish and a hope to stay HIV negative, rather than actual tried-and-true prevention science. What does it mean to be a “safe” person? It means you’re normal. You’re not a whore. You don’t let every guy cum in your ass—just the ones you trust. You’re not going to get HIV, because you’re not one of those crazy barebackers. Sure, you have sex without condoms—but only with other safe guys. Guys you can trust. Other normal guys. Magic!

Of course, I don’t know what was going through Jason’s mind when he started fucking me without a condom the second time. I suspect that if I had asked him not to use a condom the first go round, he would have balked. I’ve seen it before, and I’m sure I’ll see it again. I suspect that the second time—just mere minutes later—he may have felt a greater sense of trust with me than before.

Of course, I don’t blame him for wanting to have sex without a condom, or for trying to rely on magical thinking. I spent years in the same boat. Eventually, though, I had to face the fact that magical thinking was a highway to HIV infection and I wanted off of it. I started taking PrEP as a way of taking ownership of my desires and to stop pretending that I was a good boy who uses condoms. I know that’s a tough pill for many to swallow. We’d all like to believe that we could magically pick who is safe and who isn’t based on a gut feeling. But I’ve got some bad news: HIV don’t play that game. No, sir! That’s the whole reason we invented safer sex strategies. Those involve the use of prophylactic devices like condoms and/or PrEP and behavioral strategies such as seroadaptation—not wishing and hoping and praying.

The shift I’ve described here towards safety as an identity may well be a symptom of a much larger problem in prevention: The entire prevention arsenal aimed at HIV-negative men has basically been defunded and dismantled in favor of a narrow test-and-treat strategy. In this framework, the only responsibility HIV-negative men have to prevent HIV is to get tested to make sure they’re not actually HIV-positive. This model presumes that HIV-negative gay men will just intuitively figure HIV risk out for themselves. While some men are very savvy about risk and prevention technologies, the shift towards wishful thinking described in this piece suggests that many are not as well informed.

We should be out in the streets demanding community-based prevention initiatives that are sexy, unapologetic, and comprehensive. We need to come together to produce campaigns that combat stigma and that give men the knowledge and tools to understand, manage, and practice HIV risk responsibly. Without such efforts, we’ll be seeing increased levels of stigma, more magical thinking, and ultimately more infections.

What are you doing to demand sex-positive HIV prevention by and for gay men in your community? As always, leave a comment or shoot me an email at mylifeonprep@gmail.com.

Jake Sobo is a pen name used for anonymity. Jake has worked in the world of HIV prevention for nearly a decade. He previously published a 19-part series documenting his experiences on pre-exposure prophylaxis (PrEP), “My Life on PrEP,” for Positive Frontiers magazine, which was picked up by Manhunt, translated into French, and widely read in the HIV prevention world. He has spent the better part of his adult life having as much sex as possible while trying to avoid contracting HIV.

Comments

11 Responses to Promiscuous Gay Nerd: Wishing and Hoping and Praying—How Not to Prevent HIV

So, the notion that the problem in HIV prevention is a shift to test and treat and that we KNOW how to modify sexual behavior with current behavioral prevention strategies is magical thinking. Behavior change is difficult to secure and we have scant evidence on a population level that we can do it in the context of sexual choices. There is very little data to support a chance in incidence from our current behavior interventions. So, those working in HIV prevention need to take a cold, hard look at what the field has delivered over 30 years. The biomedical interventions, such as PrEP, treatment as prevention, PEP, circumcision work. We need to redouble our efforts to keep HIV-negative men negative, but the choices are slim in terms of ways to do this beyond the drugs discussed in this article. We’ve never held prevention researchers feet to the fire for failing to deliver as we’ve done in the treatment field. We make excuses for the lack of data, saying there are other ways to think about evidence. We shouldn’t be satisfied until HIV prevention efforts can reduce incidence, new infections, not make generalized calls for more of what we’ve done in the past.

I’ll argue this more in my next piece, but I think the treatment cascade clearly demonstrates that TasP is — actually — also a behavioral / social intervention. Putting pills in people’s mouths may seem like a silver bullet that exists somehow apart from human behavior, but it’s not.

So my next piece will address the question head-on: What can 21st century prevention for negatives look like?

While it’s true that “Use A Condom Every Time” is not working, we still need to emphasize what won’t work:serosorting for HIV-negative men. I agree that this is the major tool being used these days, and it’s the reason infection rates are rising in gay men. It’s clearly magical thinking that getting tested every few months will keep you negative, or that grilling your partners about their last test.

We need to use all the tools we have, but that’s just not one of them.

There has to be some risk reduction in guys that practice serosorting compared to those who’ll go without, specially those who insist in knowing dates of last negative testing. I’m not saying it may be terribly efficacious as an HIV preventive measure, but it should still be better than nothing.

compelling read. i haven’t followed along with this experiment originally, but how did you get prep, and how much does it cost? it must only be useful as a risk reducer for certain populations, namely the privileged ones that can afford it, and definitely not those men who don’t identify as gay. no?

You can get PrEP through your medical insurance, they seem to be covering it. http://goo.gl/6n5GJ
If you don’t have insurance now you should have it on jan 1st 2014 because of Obamacare so the cost of PrEP shouldn’t be that much of a big deal for those who are at high risk… in this case MSM reporting unprotected anal sex.

I’ve been having sex with over 10 years and these past few years I’ve observed this condom first, bare later behavior more and more often. I’m on PrEP and adhering religiously and I’m ok to fuck bare if the guy tells me that got tested negative recently and doesn’t come inside.

I’ve found out however, that if you verbally suggest to fuck without a condom most ‘safe’ guys will refuse. Bringing up any sort of PrEP talk is also a non starter as they will label you as a whore and ‘unsafe’. At the same time I can get those same guys to fuck me raw without any hesitation on the first hookup by doing one of the following:

– Before sex ask the guy if he’s negative and let him know you are negative and got tested recently. Do not mention condoms. This is pretty much sufficient and most guys will just fuck you raw when your ass is up in the air regardless what safe sex stuff they were proclaiming they do before.

– Let them use a condom first. Then they label you as a ‘safe’ fuck in their mind and they’ll proceed to fuck you raw after that. Amazingly this will carry over hookups so the ‘safe’ label remains even after multiple fucks

I’m observing this behavior more and more often and sometimes it feels like there are few people in 2013 using condoms. After having been on PrEP for a while, and while it’s working great for me, I just don’t see it deployed widely. It’s just too complicated and too much too bother for most people. Without PrEP and with the increased risk taking from people the future of HIV prevention may not be looking too good?

I won’t get HIV because I’m on PrEP and I’m an elite adherer. I am having condomless sex but I have no interest in getting HIV so I’m using a range of safer sex practices from serosorting to yes, not letting anyone come in my butt. I looked heavily into it and I’m comfortable with my risk. The risk is there but very minor. It’s more likely for me to die in a car accident than get HIV.

My partners on the other side can’t even get themselves to admit the like condomless sex and will go ahead and have unprotected sex without too much hesitation. And assuming they are not on PrEP they are putting themselves at risk and everybody else too.